Unit 1 ( health ), nursing

UNIT 1: Concept of Health

Ms.Vinay Kumari

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Introduction

The primary roles of the nurse as caregiver are to:

Promote health Prevent illness Restore health Facilitate coping

Health is more than just the absence of illness; it is an active process in which an individual moves toward wellness by reaching his or her maximum potential.

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Introduction (cont..)

To give holistic care, the nurse must understand and respect each person’s individual definition of health and response to illness and should be familiar with models of health and illness.

Finally, the nurse needs to understand how to provide nursing care to promote health and prevent illness.

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Health

Traditionally health was defined in terms of the presence or absence of disease.

Individually defined Each person defines health in terms of his

or her own values and beliefs. Acc. to WHO (World Health Organisation,

1946) Health is a state of complete physical,

mental,and social well being, and not merely the absence of disease or infirmity.

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Definitions of Health

American Nurses Association (1980)

’’A dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible.’’

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Wellness and Well-Being Wellness is a state of well being. 7 components of wellness (Anspaugh,

Hamrick, and Rosato, 2006)

1. Physical (ability to carry out daily tasks, achieve fitness, maintain adequate nutrition & proper body fat, and generally positive lifestyle habits)

2. Social (ability to interact successfully with people & within the environment)

3. Emotional (ability to manage stress & to express emotions appropriately.)

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Wellness and Well-Being

7 components of wellness (Anspaugh, Hamrick, and Rosato, 2006)

4) Intellectual (ability to learn & use information effectively for development)

5) Spiritual ( belief in some force that serves to unite human beings

6) Occupational (ability to achieve a balance between work & leisure time)

7) Environmental (ability to promote health measures that improve the standard of living & quality of life in the community)

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Wellness and Well-Being

Well being is a subjective perception of vitality and feeling well. It is a component of health.

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Models of health and illness

Agent- host- environment model Health-illness continuum High level wellness model Health promotion model Health belief model

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Agent- host- environment model

Developed by Leavell and Clark(1965) Useful for examining the causes of disease in an

individual. An agent is an environmental factor or stressor

that must be present or absent for an illness to occur.

A host is a living organism capable of being infected or affected by an agent.

The environment includes all the factors external to the host that may or may not predispose the person to the development of disease.

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Health-illness continuum

The health illness continuum is one way to measure a person’s level of health.

This model views health as a constantly changing state, with high level wellness and death being on opposite ends of a graduated scale, or continuum.

This continuum illustrates the dynamic(ever changing) state of health, as a person adapts to changes in the internal and external environments to maintain as state of well-being.

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Health illness continuum

DEATH ILLNESSHIGH

LEVELWELLNESS

NORMALHEALTH

GOODHEALTH

Illness area

Death

Well area

Well being

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Health illness continuum

People move back and forth within this continuum day by day

A person with a chronic illness may view himself or herself at different points on the continuum at any given time, depending upon how well the patient believes he or she is functioning with the illness.

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Factors/Variables affecting Health and Illness

People can usually control their health behavior and choose healthy or unhealthy activities.

Internal variables Biologic dimension Psychologic dimension Cognitive dimension

External variables Physical environment Standard of living Family and cultural beliefs Social support networks

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Internal Variables

Often described as non modifiable variable Biologic dimension1. Genetic makeup (influences biologic characteristic, innate

temperament, activity level, and intellectual potential) E.g: Diabetes, breast cancer; Africans (Hypertension , Sickle cell

anemia)

2. Gender (influences the distribution of disease ) E.g: Females ( osteoporosis, Rheumatoid arthritis) ; Males

(Stomach cancers, abd hernias)3. Age (distribution of disease varies with age. ) E.g: Heart disease (middle aged men) ;Communicable diseases

(children)4. Developmental level (major impact on health status)E.g : Toddlers learning to walk are more prone to falls

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Internal Variables (Cont…)

Psychologic dimension Mind body interaction can affect health status +vely or

–vely.Emotional responses to stress affect body functions. E.g : student anxious before test may experience diarrhea.

Self concept is how a person feels about self (self esteem) and perceives the physical self (body image), needs , roles and abilities. It affects how people view and handle situationts. Such attitudes can affect health practices, response to stress, illness etc.

E.g: Anorexia nervosa

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Internal Variables (Cont..)

Cognitive dimension Life style refers to a person’s general way of living

( living conditions and individual patterns of behavior). Lifestyle is often considered as behavior and activities over which people have control.

E.g: Overeating, Insufficient exercises are related to incidence of Heart disease ; Excessive tobacco use linked with lung cancer

Spiritual and religious believes can significantly affect health behaviour.

E.g: Some religious gp are strict vegetarian; serious illness as God’s punishment

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External variables (Cont….) Family and cultural beliefsFamily passes on patterns of daily living and lifestyle

to offspring. E.g A man who was abused as a child may physically abuse his childern

Each culture has ideas about health, and these are often transmitted to children. E.g Asians prefer herbal remedies and acupunture than analgesics

Social support network ( family, friends) and job satisfaction helps people avoids illness. Support people help the person that illness exists and provide stimulus to become well again.

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External variables

Environment Geographic location determines climate and

climate effects health (malaria more in tropical than temperate climate) : pollution;radiation

Standards of living (reflecting ocupation, income, and education) is related to health, morbidity and mortality. Hygiene, food habits, propensity to seek health care advise vary among high and low income gps.

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Illness And Disease

Illness is the highly personal state in which the persons physical ,emotional ,intellectual, social, developmental or spiritual functioning is thought to be diminished.

Not synonymous with disease. For e.g An ind. could have a disease ( growth in stomach), and not feel ill.

Illness is highly subjective; only the individual can say he or she is ill.

Disease can be described as an alteration in body functions resulting in reduction of capacities or a shortening of normal life span. Causation of disease is ETIOLOGY

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Types Of Illness

Acute illness is characterized by severe symptoms of relatively short duration. Symptoms often appear abruptly and subside quickly.

Depending on the cause, may or may not require interventions by health professionals. Following an attack, most people return to their normal level of wellness . E.g: Appendicitis, colds

Chronic illness is one that last for an extended period, usually six months or longer and often for the person’s life. Slow onset. Often have peroids of Remission( when symptoms disappear) and exacerbation ( symptoms reappear). E.g : Diabetes, heart disease.

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Causes and risk factors for developing illness

A risk factor is any situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident

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Causes and risk factors for developing illness

The presence of risk factors doesn't mean that a disease will develop, but the risk factors increase the chances that the individual will experience a particular disease or dysfunction.

1. Genetic and Physiological factors Heredity or genetic predisposition to specific

illness, is a major physical risk factor.Certain physical conditions, such as being

pregnant or overweight, place increased stress on physiological systems, increasing susceptibility to illness.

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Causes and risk factors for developing illness (Cont…)

2. Age Age increase or decreases susceptibility to certain

illnesses.3. Environment

The physical environment in which a person work or lives can increase the likelihood that certain illnesses will occur.

4. LifestyleLifestyle practices with potential negative effects are risk factors; these include sedentary lifestyle, overeating or poor nutrition, insufficient rest and sleep, and poor personal hygiene etc.

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Illness Behaviours

When people become ill, they behave in certain ways that sociologist refer to as illness behavior

Illness behavior, a coping mechanism, involves ways individual describe, monitor and interpret their symptoms, take remedial actions, and use the health care system

Variables affecting illness behavior are: age, sex, occupation, socio economic status, ethnic origin, personality, education, and modes of coping.

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Illness behaviour (cont…)

5 stages of illness ( Suchman, 1979)Stage 1: Symptom experiencesAt this stage, the person comes to believe something is wrong.3 aspects of this stage:

Physical experience of symptoms Cognitive aspect (interpretation of symptoms in terms that

have some meaning to person) Emotional aspect ( fear or anxiety)During this stage, the unwell person usually consults others

about symptoms; try home remedies .If self management is ineffective, the individual enters the next

stage.

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Stage 2: Assumption of the sick role Individual accepts sick role & seeks

confirmation; continue self treatment and delay contact with health care professionals as long as possible.

May be excused from normal duties &role expectations

Emotional responses such as withdrawal, anxiety, fear and depression are not uncommon

When symptoms persist, the person is motivated to seek professional help

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Stage 3: Medical care contactSick people seek the advise of a health professional

either on their own initiative or at the urging of significant others.

1. Validation of real illness2. Explanation of symptoms in understandable

terms3. Reassurance that they will be all right or

prediction of what the outcome will be. Client may accept or deny the diagnosis

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Stage 4: Dependent Client RoleAfter accepting the illness & seeking treatment,

the client becomes dependent on the professional for help.

Stage 5: Recovery or RehabilitationThe client is expected to resume former roles and

responsibilities. For Acute illness (illness duration is less; rapid recovery);

Chronic illness ( adjustments in life; find recovery more difficult)

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Impact of illness

Illness is never an isolated life event. The client and family must deal with changes resulting from illness & treatment.

The changes vary depending on the nature, severity, and duration of illness, attitudes associated with the illness by the client and the others, and the financial demands, the lifestyle changes incurred, adjustment to usual roles, and so on.

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Impact of illness on the client

Ill clients may experience behavioral and emotional changes, changes in self concept and body image and life style changes.

Behavioral and emotional changes associated with short term illness are generally mild and short lived

Certain illnesses can also change the clients body image

Clients self esteem and self concept may also be affected

Ill individuals are also vulnerable to loss of autonomy

Illness also often necessitates change in life style

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Impact on the family

A persons, illness affects not only the person who is ill but also the family or significant others

Role changes Task reassignments and increase demands on

time Increase stress due to anxiety about the

outcome of the illness Financial problem Loneliness Change in social customs

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Health Care Services

A health care system is the totality of services offered by all health disciplines. The services provided by health care system are commonly categorized according to type and level.

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Types of health care services

Health care services are often described in a way correlated with levels of disease prevention

A) Primary prevention (Health promotion and illness prevention)

B) Secondary prevention (Diagnosis and treatment)

C) Tertiary prevention (Rehabilitation, health restoration, palliative care )

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Types of health care services ( Cont..)

PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION

Health promotion was slow to develop until the 1980s. Since that time more and more people are recognizing the advantages of staying healthy and avoiding illness.

Primary prevention programs address areas such as adequate and proper nutrition, weight control and exercise, and stress reduction.

Health promotion activities emphasize the important role clients play in maintaining their own health and encourage them to maintain the highest level of wellness they can achieve.

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PRIMARY PREVENTION : HEALTH PROMOTION AND ILLNESS PREVENTION (Cont..)

Illness prevention programs may be directed at the client or the community and involve such practices as providing immunization, identifying risk factors for illnesses, and helping people take measures to prevent these illnesses from occurring.

Illness prevention also includes environmental programs that can reduce the incidence of illness or disability

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SECONDARY PREVENTION: DIAGNOSIS AND TREATMENT In the past, the largest segment of health care services

has been dedicated to the diagnosis and treatment of illness.

Hospitals and physician’s offices have been the major agencies offering these complex secondary prevention services

Freestanding diagnostic and treatment facilities have also evolved and serve ever growing number of clients.

Also included as health promotion service is early detection of disease. This is accomplished through routine screening of the population and focused screening of those at increased risk of developing certain conditions. E.g: Regular dental examination; voluntary HIV testing:04/08/23 37


TERTIARY PREVENTION: REHABILITATION, HEALTH RESTORATION AND PALLIATIVE CARE

The goal of tertiary prevention is to help people move their previous level of health (i.e to previous capabilities) or to the highest level they are capable of given their current health status.

Rehabilitation care emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and vocational areas of their lives.

If injury is temporary, rehabilitation can assist in return to former function. If the injury is permanent, rehabilitation assists the client in adjusting how to perform activities in order to achieve maximum abilities.

Sometimes, people cannot be returned to health. A growing field of nursing and tertiary prevention services is that of palliative care – providing comfort and treatment of symptoms

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Health Promotion, Wellness, & Illness Prevention

Health care has become increasingly focused on health promotion, wellness, and illness prevention.

Concept of health promotion, wellness, and illness prevention are closely related & in practice overlap to some extent. All are focused in future

Health promotion activities such as routine exercise and good nutrition, help clients maintain or enhance their present levels of health. Motivate people to act positively to reach more stable levels of health.

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Health Promotion, Wellness, & Illness Prevention

Wellness education teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self responsibility. Help persons achieve new understanding and control of their lives.

Illness prevention activities such as immunization prog protect clients from actual or potential threats to health. Illness prevention motivates people to avoid declines in health or functional levels.

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Health Promotion

Science and art of helping people change their lifestyles to move toward a state of optimal health.

Health promotion activities: Active and Passive

Passive (individuals gain from activities of others without acting themselves e.g fluoridation of municipal water)

Active ( individuals are motivated to adopt specific health prog e.g weight reduction)

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Levels of preventive care

Nursing care oriented to health promotion, wellness, and illness prevention can be understood in terms of health activities on primary, secondary and tertiary level.

Primary preventionTrue prevention; preceds disease or dysfunction and

applied to clients considered physically or emotionally healthy.

Aimed at health promotion includes health education programs, immunisation, physical and nutritional fitness activities.

Focus on maintaining or improving the general health of individuals, families, and communities.

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Secondary Prevention Focuses on individuals who are experiencing health

problems or illnesses and who are at risk for developing complications or worsening conditions.

Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to normal level of health as early as possible.

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Tertiary Prevention Occurs when a defect or disability is permanent

and irreversible. Involves minimizing the effects of long term disease or disability by interventions directed at preventing complications and deterioration

Activities are directed at rehabilitation rather than diagnosis and treatment.

Care at this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness.

Prevents further disability or reduced functioning.

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Health Care Agencies

Health care organizations( agencies) may be defined as structural and functional units of personnel who provide health services to individuals, families, groups, and society.

Classification Acc to focus of service

Exist mainly to provide health care (hospitals, ambulatory care centers, home health agencies)

Exist for another purpose but also include the provision of some health care as part of their services ( occupational health services, schools that provide student health services and prisons that provide dispensaries)

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Classification (Cont..) Acc to population served

Age gp: (pediatric, adult health or geriatric client)

Stage of illness: ( primary, secondary, tertiary)

Specific health problems : ( communicable diseases, drug addiction etc)

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Classification (Cont..) Acc to type of services

Specific services (diagnostic studies, counseling, formal instruction, surgery, non surgical treatment)

General services (hospitals provide a more comprehensive array of services)

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Classification (Cont..) Acc to source of fund

Profit institutions (proprietary): (receive payment from those who use their services)

Nonprofit (not-for-profit): voluntary agencies (financed by private

charitable or religious org.) public( govt. operated) agencies (funding from

local, state govt)

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Hospital

The word hospital is derived from the Latin word hospitalis- for a guest in French “hospes- a host , a guest.”

In olden days, the hospitals were guest houses for the shelter of homeless and for the treatment of travellers.In the modern times, the chief function of the hospital has been the care and treatment of sick.

A hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays.

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Definition of Hospital

The hospital is an integral part of a social and medical organization, the function of which is to provide for the population the complete health care, both curative and preventive and whose out patient services reach out to the family and its environment; the hospital is also a centre for the training of health workers and for bio- social research

(WHO)

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Hospital (Cont..)

The Changing role of hospitals Hospitals in India have come of age in the past 50 years

or so. The old idea of hospital was that it is a place for the treatment of sick. Now , with the emphasis on physical, mental, social well being, reaching out to community and training of health workers, the health care services have undergone a steady metamorphosis and the role of the hospitals has changed, with emphasis shifting from:

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Hospital (Cont..)

The Changing role of hospitals ( cont…) Curative to preventive In patient care to out patient and home care Acute to chronic illness Tertiary and secondary to primary health care

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Hospital (Cont..)

FunctionsPrimary function: provision of medical care

to community INTRA-MURAL FUNCTIONSThese functions are within the hospital,

namely:A)Therapeutic

Diagnostic : diagnosis of illness

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Hospital (Cont..)

INTRA-MURAL FUNCTIONS ( Cont..)A) Therapeutic ( Cont…) 2) Curative : Treatment of an illness

3) Rehabilitative : Physical, mental, social and vocational rehabilitation

4) Care of emergencies : Accident trauma and acute life threatening conditions

B) Preventive 1. Antenatal and postnatal services 2. Well baby clinics and immunization schedule3. Family welfare services4. Control of communicable diseases5. Health education

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Hospital (Cont..)

INTRA-MURAL FUNCTIONS ( Cont..)

c) Education1. Medical : Undergraduate, post graduate and post doctoral2. Nursing education: Undergraduate, post graduate and

post doctoral3. Specialty4. Paramedical5. Community health

D) Research1. Clinical medicine2. Hospital administration

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Hospital (Cont..)

EXTRA MURAL FUNCTIONSThose functions which are outside the

hospital, namely:1) Outpatient services2) Home care/ out reach/ domiciliary services

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Classification of Hospitals

Can be classified in many ways

A) According to ownership/ Control1. Public hospitals

Run by central/ state Govt or Municipal bodies on non commercial basis. May be general or specialized hospitals or both. General hospitals are those which provide treatment for common diseases, whereas specialized hospitals provide treatment for specific diseases, specific group of people like infectious diseases, cancer, eye, ENT, cardiac diseases

2. Voluntary ( Charitable ) hospitals Established and incorporated under the Societies Registration Act. A

board of trustees usually manages such hospitals. The main source of revenue are publics and private donations and grants aid from the Central govt./ State govt. and from philanthropic organizations, both national and international

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Classification of Hospitals

A) According to ownership/ Control3) Private hospitals

Generally owned by individuals or groups of people and are run on a commercial basis

4) Corporate hospitals Run by limited companies, formed under

the companies Act.They can be general, specialized or both.

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Classification of Hospitals ( Cont..)

B) According to clinical specialities In these hospitals, patients are treated for those diseases

for which that hospital has been set up, such as tuberculosis, cancer, cardiac diseases etc. These hospitals may be according to ownership/ control basis.

C) Acc. to length of stay In these hospitals, patients may stay for a long term or

a short term. Day care hospitals are those where parents stay from morning to evening, as members of the family may not be at home to take care of the sick.

Acute care / short term stay (with mean length of stay 7-30 days)

Long term stay ( average of length of stay over 30 days)

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Classification of Hospitals ( Cont..)

E) Acc to bed strength Small (<100 beds) Medium sized (100-300 beds) Large (> 300 beds)

F) Acc. to teaching and non teaching A teaching hospital has a medical

college attached to it. A hospital without a medical college is termed as a non teaching hospital .

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Physical Plan of the hospital

SELECTION OF SITE Place should not be densely populated Site of the hospital should be elevated from the

surroundings Should have an independent access to a street Must be away from nuisance such as dust, smoke,

bad odor, excessive noise and traffic Open space all around will help in proper lighting

(natural), and ventilations will provide a pleasing surrounding

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PROVISION OF Safe drinking water Adequate lighting and ventilation Control of noise Collection and safe disposal of refuse and

excreta Control of arthropods, vermin and animal

pests

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Important points to be considered while constructing a hospital Walls and floor should be, as far as

possible, non absorbent, non porous, shock absorbing, attractive, fire resistant, durable, easy to clean, and damp proof, free of cracks (prevent breeding of insects)

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Physical Plan of the hospital (Cont..)

Important points to be considered while constructing a hospital Floor area should be adequate acc. to the no. of beds, so

there is sufficient space between the beds (6 feet) Windows and doors should be placed in such a way that

natural lighting is available in the room with cross ventilation

Latrines are placed in such a way that it does not cause bad odor and unpleasant scenes. Should be placed where direct sunlight enters in.

Reception counter and the OPD should be near to the main entrance of the hospital. IPD can be towards the back of the building.

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Physical Plan of the hospital (Cont..)

Important points to be considered while constructing a hospital The kitchen and the dining rooms should be fly proof and

away from the hospital wards. There should be central corridor connecting the different

departments and wards. There should be provision for the isolation of patients having

infectious diseases or who are suspected to be infectious. There should be railings along the open corridors and

staircases to prevent accidents by falling Staircases, ramps and elevators should be centrally placed

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Organization of hospital

Organization varies from hospital to hospital. Some feature are common to all.

Line of authority differs acc. to the ownership and administration.

The governing body of a hospital, usually called the board of trustees or directors is responsible for the policies of the institution. Directly under the governing body is the head of the hospital, the administrator or director, to whom authority and responsibility for management is delegated.

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Organization of hospital (Cont..)

The administrator/ director directs two divisions of the hospital work- the business management and the professional care of the patients.

The business management includes administration, accounting, maintenance, engineering, housekeeping and purchasing.

Under the professional care of the patients are found the medical, nursing, paramedical and other special department.

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MAJOR DEPARTMENTS Medical department (Medical superintendent is a

doctor who has control over all the medical dept.) Nursing department Paramedical department

Pathology dept ( Bacteriology lab, biochemistry lab, hematology lab, parasitology lab, serology lab, Blood Bank, Histopathology dept )

Pharmacy dept (selecting, purchasing, compounding, storing and dispensing all drugs )

Physical medicine and rehabilitation Radiology dept Dietary dept

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MAJOR DEPARTMENTS NON PROFESSIONAL SERVICES (BUSINESS MX)

Admitting dept Administration Personnel dept ( recruitment, interview, promotion, transfer, inservice

training, safety, health prog, recreation) Purchasing dept Medical records Accounts (Business office) Housekeeping (to keep hospital clean) Laundry Mechanical dept (electricity, water supply,heat.) Maintenance dept (carpenter, painters, welders, gardners Central supply dept Social services

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Primary Health care

Originally conceptualized in 1978 by the WHO and the United Nations International Children’s Emergency Relief Fund (UNICEF)

Concept was developed based on decreases in illness and death in member countries that were achieved by simple, local, inexpensive solutions to health problems, especially when combined with economic and social development.

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Primary Health care

Defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost the community can afford

“Primary health care is essential health care, made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.” (Alma Ata conference)

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Primary Health care (Cont…)

Not to be confused with primary care. Primary care is the delivery of healthcare services, including the initial contact and ongoing care.

Included in primary care is the responsibility for referral to other providers based on patient needs. Both physicians and nurse practitioners provide primary care, which focuses on individual patient and is directed by the provider.

In contrast, primary health care has a community based philosophic base that emphasizes universal access and affordability of health care, health of whole population, and consumer involvement.

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Principles of primary health care

1.Equitable distributionHealth services must be shared equally by all people

irrespective of their ability to pay and all (rich or poor, urban or rural) must have access to health services. Primary health care aims to address the current imbalance in health care by shifting the centre of gravity from cities where a majority of the health budget is spent to rural areas where a majority of people live in most countries.

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Principles of primary health care

2. Community participation There must be a continuing effort to secure meaningful

involvement of the community in the planning, implementation and maintenance of health services, beside maximum reliance on local resources such as manpower, money and materials.

3. Intersectoral coordinationPrimary health care involves in addition to the health sector, all

related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors.

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Principles of primary health care 4. Appropriate technology“Technology that is scientifically sound, adaptable

to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources the community and country can afford.”

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8 Essential elements of primary health care 1. Education- concerning prevailing health problems and

the methods of preventing and controlling them2. Promotion of food supply and proper nutrition3. An adequate supply of safe water and basic sanitation4. Maternal and child health care, including family

planning5. Immunisation against major infectious diseases6. Prevention and control of locally endemic diseases7. Appropriate treatment of common diseases and injuries8. Provision of essential drugs

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Role of Nurse Assessing the health status of individuals and

community. Promoting community involvement Providing integrated health care including the

treatment of emergencies and making referrals. Making epidemiological surveillance. Training and supervising health workers. Collaborating with other developmental sectors Monitoring progress in primary health care

Body defenses: Immunity and Immunization

Introduction

Individuals normally have defenses that protect the body from infection.

These defenses can be categorized as specific and non specific.

Non specific defenses protect the person against all microorganisms, regardless of prior exposure.

Specific immune) defenses, by contrast, are directed against identifiable bacteria, viruses, fungi, or other infectious agents.

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Non Specific Defenses

Nonspecific body defenses include anatomic and physiologic barriers, and the inflammatory responses.

Anatomic and Physiologic Barriers Intact skin and mucous membrane : first line of

defense against micro-organisms. Normal secretions make the skin slightly acidic; acidity

also inhibits bacterial growth. Nasal passages have a defensive function. Moist

mucus membranes and cilia trap microorganisms, dust, foreign materials.

Lungs have alveolar macrophages (large phagocytes) that ingest microorganisms, other cells, and foreign particles.

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Non Specific Defenses (Cont…)

Anatomic and Physiologic Barriers (Cont…) Each body orifice also has protective mechanisms.

The oral cavity regularly sheds mucosal epithelium to rid the colonizers. Saliva contains microbial inhibitors such as lactoferrin, lysozyme and secretory IgA.

Eye is proteced from infection by tears, which continually wash microorganisms away and contain inhibiting lysozyme.

High acidity of stomach normally prevents microbial growth.

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Inflammatory Responses Inflammation is a local and nonspecific

defensive response of tissues to an injurious or infectious agent.

It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents further spread of injury, and promotes the repair of damaged tissue.

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Inflammatory Responses (Cont..) It is characterized by 5 signs:

1. Pain2. Swelling3. Redness4. Heat5. Impaired function of the part, if the injury is severe.

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Inflammatory Responses (Cont..) A series of dynamic events commonly referred to as

the 3 stages of inflammatory response

1. First Stage: Vascular and cellular ResponsesAt the start of 1st stage, blood vessels at the site of injury constrict. This is rapidly followed by dilation of small blood vessels (occurring as a result of histamine released by injured tissues). Thus, more blood flows to the injured area( hyperemia) and is responsible for the characteristic signs of redness and heat.Vascular permeability increases at the site with dilation of the vessels in response to cell death, the release of chemical mediators (e.g bradykinin, serotonin, prostaglandins) and histamine.

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Inflammatory Responses (Cont..)1. First Stage: Vascular and cellular

ResponsesFluid, proteins and leukocytes leak into interstitial spaces, and the signs of inflammation swelling (edema) and pain appear.

Pain is caused by pressure of accumulating fluid on nerve endings and the irritating chemical mediators. Leukocytosis (large no of leukocytes produced by bone marrow and released into blood stream). Leukocytes move through the blood wall into the affected tissue spaces.


Inflammatory Responses (Cont..)2. Second Stage : Exudate production

The inflammatory exudate is produced, consisting of fluid that escaped from the blood vessels, dead phagocytic cells, and dead tissue cells and products that they release.

The plasma protein fibrinogen ( which is converted into fibrin when it is released into the tissues), thromboplastin (released by injured tissue cells), and platelets together form an interlacing network to wall off the area, and prevent spread of injurious agent.

During this stage, the injurious agent is overcome, and the exudate is cleared by lymphatic drainage.

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Inflammatory Responses (Cont..)3) Third Stage : Reparative Phase

Involves the repair of injured tissues by regeneration or replacement with fibrous tissue( scar) formation. Regeneration is the replacement of destroyed tissue cells by cells that are identical in structure and function.When regeneration is not possible, repair occurs by fibrous (scar) tissue formation. Damaged tissues are replaced with the connective tissue elements of collagen, blood capillaries, lymphatics.

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Inflammatory Responses (Cont..)3) Third Stage : Reparative Phase

In the early stages of this process, the tissue is called granulation tissue (fragile, gelatinous, pink or red)Later, the tissue shrinks, capillaries constrict and collagen fibers contract, so that a firmer fibrous tissue remains. This is called as cicatrix or scar.

Specific defenses

Specific defenses of the body involve the immune system.

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Immunity

Immunity is a material term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion.

An antigen is a substance that induces a state of sensitivity or immune responsiveness (immunity).

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Types of Immunity

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IMMUNITY

NATURAL ACQUIRED

ACTIVE(INFECTION)

ACTIVE(IMMUNISATION)

PASSIVE

(ANTIBODY TRANSFER)PASSIVE(MATERNAL)

Active and passive immunity

Passive immunity is acquired through transfer of antibody or activated T-cells from an immune host, and is short lived, usually lasts only a few months, whereas active immunity is induced in the host itself by antigen, and lasts much longer, sometimes life-long.

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Components of immune response

Immune response has two components: Antibody mediated defenses and cell mediated defenses. These two systems provide distinct but overlapping protection.

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Components of immune response (Cont…)

Antibody mediated defenses ( Humoral or circulating immunity) These defenses reside ultimately in the

B lymphocytes and are mediated by antibodies (immunoglobulin) produced by B cells. The antibody mediated responses defend primarily against the extra cellular phases of bacterial and viral infections.

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Antibody mediated defenses ( Humoral or circulating immunity) Active immunity (host produces antibodies in response

to natural antigens (e.g infectious microorganisms) or artificial antigens (e.g. vaccines). B cells are activated when they recognize antigen. Bcells may produce antibody molecules of 5 classes of immunoglobulins (IgM, IgG, IgA, IgD, and IgE.)

Passive immunity the host receives natural (e.g from nursing mother) or artificial(from an injection of immune serum) antibodies produced by another source.

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Cell mediated defenses ( Cellular immunity) The cell mediated defenses or cellular immunity, occur

through the T cell system. On exposure to an antigen, the lymphoid tissues release large numbers of activated T cells into the lymph system. These T cells pass into general circulation. There are 3 main gps of T cells

helper T cells, which help in the functions of immune system cytotoxic T cells, which attack and kill microorganisms and

sometimes the body's own cells suppressor Tcells which can suppress the functions of the helper T

cells and cytotoxic T cells

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Immunisation

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Immunisation

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).

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Passive and active immunization

Immunisation can be achieved in an active or passive fashion: vaccination is an active form of immunization.

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Active immunization

Active immunisation entails the introduction of a foreign molecule into the body, which causes the body itself to generate immunity against the target. This immunity comes from the T cells and the B cells with their antibodies.

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ACTIVE IMMUNISATION

NATURAL ARTIFICIAL

Active immunization

Active immunization can occur naturally when a person comes in contact with, for example, a microbe. If the person has not yet come into contact with the microbe and has no pre-made antibodies for defense (like in passive immunization), the person can become immunized. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune

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Active immunization

Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated, so that they will not harm the injected person as the naturally occurring microbe would. Depending on the type of disease, this technique also works with dead microbes, parts of the microbe, or treated toxins from the microbe.

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Passive immunization

Passive immunization is where pre-made elements of the immune system are transferred to a person, and the body doesn't have to create these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear

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Passive immunization can be naturally acquired when antibodies are being transferred from mother to fetus during pregnancy , to help protect the fetus before and shortly after birth.

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Artificial passive immunization is normally given by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment to poisons (for example, for tetanus).

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National Immunization Schedule

AGE VACCINE DOSE ROUTE

BIRTH BCG 1 ID

OPV 0 ORAL

6 WEEKS OPV 1 ORAL

DPT 1 IM

10 WEEKS OPV 2 ORAL

DPT 2 IM

14 WEEKS OPV 3 ORAL

DPT 3 IM

National Immunization Schedule

AGE VACCINE DOSE ROUTE

9 MONTHS MEASLES 1 SC

18 MONTHS DPT 1 BOOSTER IM

OPV 1 BOOSTER ORAL

5 YEARS DT 1 IM

10 YEARS TT 1 IM

16 YEARS TT 1 IM

Optional Vaccines

AGE AGE DOSE ROUTE

HEPATITIS B BIRTH 1 IM

10 WEEKS 2 IM

9 MONTHS 3 IM

HEPATITIS A 1 YEAR 1 IM

1 AND ½ YEAR 2 IM

H. INFLUENZA-B (HIB)

06 MONTHS 1 IM

14 MONTHS 2 IM

18 MONTHS 3 IM

MMR 15 MONTHS 1 IM

CHIKENPOX 24 MONTHS 1 IM

TYPHOID 5 YEARS 2 IM

UNIT TEST ON THIS UNITCOMPULSORY FOR ALL

DURATION : 1 HRMM: 35

(28/11/08 : FRIDAY)Time: 1.45 to 2.30 PM

Unit 1 ( health ), nursing

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